耻骨上前列腺摘除术后四大并发症的中医辨证研究

Study by TCM Differentiation on Complications of 310 Cases After Suprapubic Prostatectomy

目的 研究耻骨上经膀胱前列腺摘除术后患者状态及并发症 ,确立中医辨证种类和证型分布规律。方法 回顾了耻骨上经膀胱前列腺摘除术病例 310例 ,依据术后患者状态 ,建立计算机数据库 ,经多元统计分析 ,聚类分析 ,按照《中医病证诊断疗效标准》及《中医症候规范》 ,结合专家辨证进行研究。结果 总结出六大症候群 ,经专家辨证为 :脾气虚、气虚下陷、气血两虚、肾阳虚、肾阴虚、湿热夹瘀。据此分析四大并发症的证型分布规律 :并发出血患者 14例 ,以虚证为主 ,兼有血瘀 ;并发尿失禁患者 37例 ,以气虚下陷和肾阳虚为主 ;并发尿路梗阻患者 12例 ,湿、热、瘀为主 ;并发附睾炎患者 14例 ,证型分布均为肾虚湿热型。结论 耻骨上经膀胱前列腺摘除术后可分为六类证型 :脾气虚、气虚下陷、气血两虚、肾阳虚、肾阴虚、湿热夹瘀。并发出血、尿失禁者以虚证为主 ,并发尿路梗阻、附睾炎患者多兼湿、热、瘀。

Objective The states and four complications of patients after suprapubic prostatectomy (SP) were studied. Their differentiation types and contribution law of syndromes were determined. Method 310 cases of SP were reviewed. According to their states and postoperative complications a questionnaire and computer base were established, and a study was conducted through multiple statistical analysis, referencing Curative Effect Standard of Syndrome Diagnosis of TCM and Criterion of TCM Syndromes, integrating the differentiation made by the experts. Result Six syndrome groups were summarized and they were syndromes of deficiency of spleen-qi, sinking of qi, deficiency of qi and blood, deficiency of kidney-yang, deficiency of kidney-ying and damp-heat combined with phlegm. Then 4 postoperative complications were analyzed and decided as follows: 14 cases complicated hemorrhage with efficiency syndrome accompanying blood stasis; 37 cases, urinary incontinence with sinking of qi and deficiency of kidney-yang; 12 cases, urethral stricture with damp-heat combined with phlegm; 14 cases, epididymitis with kidney deficiency and damp-heat. Conclusion Suprapubic prostatectomy included six syndromes according to TCM theory. They were syndromes of deficiency of spleen-qi, sinking of qi, deficiency of qi and blood, deficiency of kidney-yang, deficiency of kidney-ying and damp-heat combined with phlegm. The complications of hemorrhage and urinary incontinence were mostly efficiency syndromes, and urethral stricture and epididymitis were accompanied by dampness, heat and phlegm mainly.